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Staging: Rectal Cancer (All Stages)

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The staging system the medical community uses is the TNM system:

  • T for tumor indicates the depth of invasion of the tumor. T is determined when the tumor is removed and sent to the pathologist.
  • N for nodes indicates the presence of cancer cells in the lymph nodes. Lymph nodes are checked for tumor spread at the time of surgery.
  • M for metastasis indicates spread of the cancer to other organs. M is determined with x-rays, scans and blood tests.
  • For more information about staging in general, click here.

Following are the basic stages of rectal cancer.

Stage 0: Tis, N0, M0

The earliest possible stage. Cancer has not moved from where it started. It is still only in the innermost lining of the colon wall (the mucosa). These abnormal cells may become cancer and spread into nearby tissue. Stage 0 is sometimes referred to as “Carcinoma In Situ”

Stage 0 colon/rectal carcinoma in situ; shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with abnormal cells in the mucosa layer. Also shown are the submucosa, muscle layers, serosa, a blood vessel, and lymph nodes.

Image countesy of National Cancer Institute

Stage I T1, N0, M0; T2 N0, M0

In stage I, the cancer has begun to spread, but is still only in the inner lining of the colon.  The cancer has spread beyond the innermost tissue layer of the colon wall to the middle layers which are known as submucosa (the layer of tissue under the mucosa). Stage 1 is also known as “Dukes A Colorectal Cancer”.

Stage I colorectal cancer; shows a cross-section of the colon/rectum. An inset shows the layers of the colon/rectum wall with cancer in the mucosa, submucosa, and muscle layers. Also shown are the serosa, a blood vessel, and lymph nodes. offsite link

Image countesy of National Cancer Institute

Stage II

In stage II, the cancer has not spread to lymph nodes but may have spread to nearby organs. Colon Cancer is divided into stages IIA, IIB and IIC. Stage II is also known as “Dukes B Colorectal Cancer”.

  • Stage IIA:  T3, N0, M0: Cancer has spread beyond the middle tissue layers of the colon wall to the outermost layer of the colon wall (the serosa) or has spread to nearby tissues around the colon or rectum.
  • Stage IIB: T4a, N0, M0: Cancer has spread beyond the colon wall but has not spread to nearby organs.
  • Stage IIC: T4b, N0, M0: Cancer has spread beyond the colon wall outer layer to nearby organs.

Stage II colorectal cancer; shows a cross-section of the colon/rectum and a three-panel inset. Each panel shows the layers of the colon/rectum wall: mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. First panel shows stage IIA with cancer in the mucosa, submucosa, muscle layers, and serosa. Second panel shows stage IIB with cancer in all layers and spreading through the serosa. Third panel shows stage IIC with cancer spreading to nearby organs.

Image countesy of National Cancer Institute
Stage III  

In stage III, rectal cancer has spread outside the colon to the regional lymph nodes. Rectal cancer is divided into stages IIIA, IIIB and IIIC. Stage III is also known as “Dukes C Colorectal Cancer”.

  • Stage IIIA T1-T2, N1, M0
    • Cancer may have spread through the innermost layer (the mucosa) of the colon wall to the  layer of tissue offsite link under the mucosa (the submucosa) and may have spread to the muscle layer of the colon wall. Cancer has spread to at least one but not more than 3 nearby lymph nodes offsite link or cancer cells offsite link have formed in tissues near the lymph nodes; or
    • Cancer has spread through the innermost layer (the mucosa) of the colon wall to the layer of tissue under the mucosa. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes.
    • Stage IIIA colorectal cancer; shows a cross-section of the colon/rectum and a two-panel inset. Each panel shows the layers of the colon/rectum wall: mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. First panel shows cancer in the mucosa, submucosa, muscle layers, and 2 lymph nodes. Second panel  shows cancer in the mucosa, submucosa, and 5 lymph nodes. offsite link
  • Stage IIIB T3-T4a, N1, M0 or T2-T3, N2a, M0 or T1-T2, N2b, M0
    • Cancer has spread through the muscle layer of the colon offsite link wall to the outermost layer (the serosa) of the colon wall or has spread through the serosa but not to nearby organs offsite link. Cancer has spread to at least one but not more than 3 nearby lymph nodes offsite link or cancer cells offsite link have formed in tissues offsite link near the lymph nodes; or
    • Cancer has spread to the muscle layer of the colon wall or to the outmost layer (the serosa)  of the colon wall. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes; or
    • Cancer has spread through the innermost layer of the colon wall (the mucosa) to the layer of tissue under the mucosa (the submucosa)) and may have spread to the muscle layer of the colon wall. Cancer has spread to 7 or more nearby lymph nodes.
    • Stage IIIB colorectal cancer; shows a cross-section of the colon/rectum and a two-panel inset. Each panel shows the layers of the colon/rectum wall: mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. First panel shows cancer in all layers, spreading through the serosa, and in 3 lymph nodes. Second panel shows cancer in all layers and in 5 lymph nodes. Third panel shows cancer in the mucosa, submucosa, muscle layers, and 7 lymph nodes. offsite link
  • Stage IIIC T4a, N2a, M0 or T3-T4a, N2b, M0, or T4b, N1-N2, M0
    • Cancer offsite link has spread through the outermost layer of the colon offsite link wall (the serosa) but has not spread to nearby organs offsite link. Cancer has spread to at least 4 but not more than 6 nearby lymph nodes offsite link; or
    • Cancer has spread through the muscle layer of the colon wall to the outmost layer of the colon wall (the serosa) or has spread through the serosa but has not spread to nearby organs. Cancer has spread to 7 or more nearby lymph nodes; or
    • Cancer has spread through the outermost layer of the colon wall (the serosa)and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues offsite link near the lymph nodes.
    • Stage IIIC colorectal cancer; shows a cross-section of the colon/rectum wall and a three-panel inset. Each panel shows the layers of the colon/rectum wall: mucosa, submucosa, muscle layers, and serosa. Also shown are a blood vessel and lymph nodes. First panel shows cancer in all layers, spreading through the serosa, and in 4 lymph nodes. Second panel shows cancer in all layers and in 7 lymph nodes. Third panel shows cancer in all layers, spreading through the serosa, in 2 lymph nodes, and spreading to nearby organs. offsite link Image countesy of National Cancer Institute

Stage IV

The cancer has spread through the lymph system or blood stream to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colon cancer are the liver and then the lung. Stage IV is also known as “Dukes D Colorectal Cancer.” Stage IV rectal cancer is divided into stage IVA and stage IVB.

Stage IVA: any T, any N, M1a: Cancer may have spread through the colon offsite link wall and may have spread to nearby organs offsite link or lymph nodes offsite link. Cancer has spread to one organ that is not near the colon, such as the liver offsite linklung offsite link, or ovary offsite link, or to a distant lymph node.

Stage IVB: any T, any N, M1b:  Cancer may have spread through the colon offsite link wall and may have spread to nearby organs offsite link or lymph nodes offsite link. Cancer has spread to more than one organ that is not near the colon or into the lining of the abdominal offsite link wall.

Stage IV rectal cancer; drawing shows other parts of the body where rectal cancer may spread, including lymph nodes, lung, liver, abdominal wall, and ovary. Inset shows cancer spreading through the blood and lymph nodes to other parts of the body. offsite link

Image countesy of National Cancer Institute

 

For additional information about staging, see the American Joint Committee on Cancer (AJCC) staging information at: http://www.cancerstaging.org/staging/index.html offsite link.


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